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Please complete ALL the sections below

Introducer code (If applicable)
Your E-mail Address
Telephone Number
Title
First Name
Surname
Address
Postcode
   
Licence  

Licensing Authority

 eg Wakefield
Is the council vehicle licence in your name
How many passengers are you licensed to carry
Public or Private Hire Licence

Base office Postcode
Vehicle Details  
Vehicle Make ie. Ford
Model ie. Mondeo
Spec ie, LXTD
Vehicle Registration
Engine Size
Current Value £
Year of Make (ie 1998)
Date of Purchase (ie DD,MM,YY)
Where is vehicle kept

Are you the owner & registered keeper

Fuel Type

Are there any modifications
Details
   
Insurance Details  
Cover Required
Annual Mileage Covered
How many years NCB for use on the policy
Bonus earned Taxi / Private Hire / Private Use / Private Car
Existing Insurers Name
Required Protected NCB
Policy Expiry Date (DD,MM,YY)
Are you a Homeowner
Is this a new venture
Is there Wheelchair Access
How many vehicles do you insure for hire/reward
Number of drivers, including yourself


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